| National Provider Identifier [NPI]: | 1336490333 |
| Last Name Of The Provider | COPP |
| First Name Of The Provider | SUSAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | CNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 900 MAIN ST |
| Street Address 2 Of The Provider | SUITE 600 |
| City Of The Provider | PEORIA |
| Zip Code Of The Provider | 616021005 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 12 |
| Number Of Services | 495 |
| Number Of Medicare Beneficiaries | 98 |
| Total Submitted Charge Amount | 35377 |
| Total Medicare Allowed Amount | 18049.89 |
| Total Medicare Payment Amount | 12416.5 |
| Total Medicare Standardized Payment Amount | 15297.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 233 |
| Number Of Medicare Beneficiaries With Drug Services | 27 |
| Total Drug Submitted ChargeAmount | 1730 |
| Total Drug Medicare AllowedAmount | 856.67 |
| Total Drug Medicare PaymentAmount | 636.25 |
| Total Drug Medicare Standardized Payment Amount | 636.25 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 10 |
| Number Of Medical Services | 262 |
| Number Of Medicare Beneficiaries With Medical Services | 97 |
| Total Medical Submitted Charge Amount | 33647 |
| Total Medical Medicare Allowed Amount | 17193.22 |
| Total Medical Medicare Payment Amount | 11780.25 |
| Total Medical Medicare Standardized Payment Amount | 14660.97 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 49 |
| Number Of Beneficiaries Age 75 to 84 | 23 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 67 |
| Number Of Male Beneficiaries | 31 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 80 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 18 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0624 |